Positive pre-biopsy MRI: are systematic biopsies still useful in addition to targeted biopsies?
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The diagnostic strategy implementing multiparametric magnet resonance tomography (mpMRI) and targeted biopsies (TB) improves the detection and characterization of significant prostate cancer (PCa). We aimed to assess the clinical usefulness of systematic biopsies (SB) in the setting of patients having a pre-biopsy positive MRI.
A review of the literature was performed in March 2018. All studies investigating the performance of SB in addition to TB (all techniques) were assessed, both in the biopsy-naïve and repeat biopsy setting.
Evidence demonstrates that TB improves the detection of index-significant PCa compared with SB alone, in both initial and repeat biopsy settings. However, the combination of both TB and SB improved the overall (around 30%) and significant (around 10%) PCa detection rates as compared with TB alone. Significant differences between both biopsy approaches exist regarding cancer location favoring SB for the far lateral sampling, and TB for the anterior zone. Main current pitfalls of pure TB strategy are the learning curve and experience required for mpMRI reading and biopsy targeting, as well as the precision assessment in TB techniques.
A pure TB strategy omitting SB leads to the risk of missing up to 15% of significant cancer, due to limitations of mpMRI performance/reading and of precision during lesion targeting. SB remain necessary, in addition to the TB, to obtain the most accurate assessment of the entire prostate gland in this sub-group of patients at risk of significant disease.
KeywordsProstate cancer Detection Biopsy Fusion Targeted Magnetic resonance imaging
Guillaume Ploussard: Protocol/Project Development, Data collection, data writing. Hendrik Borgmann: Critical revision, editing. Alberto Briganti: Critical revision, editing. Pieter de Visschere: Critical revision, editing. Jurgen J. Fütterer: Critical revision, editing. Giorgio Gandaglia: Critical revision, editing. Isabel Heidegger: Critical revision, editing. Alexander Kretschmer: Critical revision, editing. Romain Mathieu: Critical revision, editing. Piet Ost: Critical revision, editing. Prasanna Sooriakumaran: Critical revision, editing. Cristian Surcel: Critical revision, editing. Derya Tilki: Critical revision, editing. Igor Tsaur: Critical revision, editing. Massimo Valerio: Critical revision, editing. Roderick van den Bergh: Protocol/Project Development, Data collection, data writing.
Compliance with ethical standards
Conflict of interest
The authors declared that they have no conflict of interest.
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